Can Pelvic Lymphadenectomy be Omitted in Stage IA2 to IIB Uterine Cervical Cancer?

ObjectivesThe aims of this study were to predict pelvic lymph node metastasis in uterine cervical cancer before surgery and to evaluate the potential efficacy of omitting pelvic lymphadenectomy.Materials and MethodsA total of 163 patients with invasive uterine cervical cancer in FIGO stage IA2 to IIB, all of whom underwent primary radical hysterectomy with pelvic lymphadenectomy, participated in this study.ResultsThe incidences of pelvic lymph node metastasis in stage IA2, stage IB1, stage IB2, stage IIA, and stage IIB cervical cancer were 0% (0/12), 17% (13/76), 22% (6/27), 33% (8/24), and 63% (15/24), respectively. A significant difference was observed in overall survival with nodal metastasis status (P< 0.0001). Univariate analysis revealed that parametrial invasion (P< 0.0001), tumor markers (P= 0.0006), tumor size greater than 2 cm (P< 0.0001), tumor size less than 3 cm (P= 0.0009), and tumor size greater than 4 cm (P= 0.0024) were correlated with pelvic lymph node metastasis. However, multivariate analysis revealed that parametrial invasion (P= 0.01; odds ratio, 3.37; 95% confidence interval, 1.31–9.0) and tumor size greater than 2 cm (P= 0.005; odds ratio, 4.93; 95% confidence interval, 1.54–22.01) were independently associated with nodal metastasis.ConclusionsPelvic lymphadenectomy may be avoided in patients with negative parametrial invasion and a tumor size less than 2 cm, thereby minimizing postoperative complications.

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Identification of risk factors associated with pelvic lymph node metastasis in patients with stage IB1 cervical cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18005 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18005-e18005

Author(s):

Ping Jiang ◽

Jing Cai ◽

Xiaoqi He ◽

Hongbo Wang ◽

Weihong Dong ◽

...

Keyword(s):

Risk Factors ◽

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Tumor Size ◽

Node Metastasis ◽

Parametrial Invasion ◽

Pelvic Lymph Node Metastasis ◽

Internal Iliac

e18005 Background: Evaluation the distribution of nodal metastases in the stage IB1 cervical cancer and the risk factors associated with pelvic lymph node metastasis (LNM) at each anatomic location. Methods: 728 patients with stage IB1 cervical cancer who underwent radical hysterectomies and systemic pelvic lymphadenectomies from January 2008 to December 2017 were retrospectively studied. All removed pelvic lymph nodes were pathologically examined, and the risk factors for LNM at the obturator, internal iliac, external iliac, and common iliac regions were evaluated by univariate and multivariate logistic regression analyses. Results: 20,134 lymph nodes were analysed with the average number of 27.80 (± SD 9.43) lymph nodes per patient. Nodal metastases were present in 266 (14.6%) patients. The obturator was the most common site for nodal metastasis (42.5%) followed by the internal iliac nodes (20.3%) and the external iliac nodes (19.9%), while the common iliac (9.8%) and parametrial (7.5%) nodes were the least likely to be involved. Tumor size more than 2 cm, histologically proven lymphovascular space involvement (LVSI) and parametrial invasion correlated independently significantly with the higher risk of the lymphatic metastasis. Obesity (BMI≥25) was independently significantly negatively correlated with the risk of lymphatic metastases. All the positive common iliac nodes were found in patients with tumors greater than 2 cm. The multivariate analysis showed that tumor size greater than 3 cm was associated with a 16.6-fold increase in the risk for common iliac LNM. Interestingly, tumor size was not an independent risk factor for pelvic LNM in the lower regions, i.e., the obturator, internal iliac and external iliac areas, where LVSI was the most significant predictor for LNM. In addition, parametrial invasion was related to external and internal iliac LNM; deep stromal invasion and age less than 50 years were associated with obturator LNM. Conclusions: The incidence of lymph node metastasis in patients with stage IB1 cervical cancer is low but prognostically relevant. The data offer the opportunity for tailored individual treatment in selected patients with small tumors and obesity.

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C14ORF166 overexpression is associated with pelvic lymph node metastasis and poor prognosis in uterine cervical cancer

Tumor Biology ◽

10.1007/s13277-015-3806-3 ◽

2015 ◽

Vol 37 (1) ◽

pp. 369-379 ◽

Cited By ~ 15

Author(s):

Weijing Zhang ◽

Jianping Ou ◽

Fangyong Lei ◽

Teng Hou ◽

Shu Wu ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Poor Prognosis ◽

Uterine Cervical Cancer ◽

Pelvic Lymph Node ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis

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Pelvic lymph node metastasis of uterine cervical cancer

Gynecologic Oncology ◽

10.1016/0090-8258(87)90287-3 ◽

1987 ◽

Vol 27 (2) ◽

pp. 150-158 ◽

Cited By ~ 50

Author(s):

Hiroshi Noguchi ◽

Isao Shiozawa ◽

Yoshikimi Sakai ◽

Teruyuki Yamazaki ◽

Toru Fukuta

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Uterine Cervical Cancer ◽

Pelvic Lymph Node ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis

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Comparison of Survival Outcomes with or Without Para-aortic Lymphadenectomy in Surgical Patients with Stage IB1-IIA2 Cervical Cancer in China from 2004-2016

10.21203/rs.3.rs-506335/v1 ◽

2021 ◽

Author(s):

Chunlin Chen ◽

Hui Duan ◽

Wenling Zhang ◽

Hongwei Zhao ◽

Li Wang ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Pelvic Lymphadenectomy ◽

Pelvic Lymph Node ◽

Surgical Patients ◽

Survival Outcomes ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis ◽

Aortic Lymph Node

Abstract Background: Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer.Methods: We retrospectively compared the survival outcomes of 8802 cervical cancer patients with stage IB1-IIA2 (FIGO 2009) from 37 hospitals in mainland China, who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n=8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n=357).Results: Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastasis, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph node metastasized, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion: Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

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P31 Good interobserver agreement for mri-based assessment of tumor size≥4 cm, parametrial invasion and lymph node metastasis in uterine cervical cancer

10.1136/ijgc-2019-esgo.94 ◽

2019 ◽

Author(s):

N Lura

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Tumor Size ◽

Interobserver Agreement ◽

Uterine Cervical Cancer ◽

Node Metastasis ◽

Parametrial Invasion

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EP-1345: Radiation therapy for pelvic lymph node metastasis from uterine cervical cancer

Radiotherapy and Oncology ◽

10.1016/s0167-8140(15)31463-8 ◽

2014 ◽

Vol 111 ◽

pp. S103-S104

Author(s):

M. Hata ◽

I. Koike ◽

E. Miyagi ◽

R. Numazaki ◽

M. Asai-Sato ◽

...

Keyword(s):

Cervical Cancer ◽

Radiation Therapy ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Uterine Cervical Cancer ◽

Pelvic Lymph Node ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis

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Comparison of survival outcomes with or without Para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer in China from 2004 to 2016

BMC Cancer ◽

10.1186/s12885-021-08797-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chunlin Chen ◽

Hui Duan ◽

Wenling Zhang ◽

Hongwei Zhao ◽

Li Wang ◽

...

Keyword(s):

Cervical Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Pelvic Lymphadenectomy ◽

Pelvic Lymph Node ◽

Surgical Patients ◽

Survival Outcomes ◽

Node Metastasis ◽

Pelvic Lymph Node Metastasis ◽

Aortic Lymph Node

Abstract Background Current opinions on whether surgical patients with cervical cancer should undergo para-aortic lymphadenectomy at the same time are inconsistent. The present study examined differences in survival outcomes with or without para-aortic lymphadenectomy in surgical patients with stage IB1-IIA2 cervical cancer. Methods We retrospectively compared the survival outcomes of 8802 stage IB1-IIA2 cervical cancer patients (FIGO 2009) who underwent abdominal radical hysterectomy + pelvic lymphadenectomy (n = 8445) or abdominal radical hysterectomy + pelvic lymphadenectomy + para-aortic lymphadenectomy (n = 357) from 37 hospitals in mainland China. Results Among the 8802 patients with stage IB1-IIA2 cervical cancer, 1618 (18.38%) patients had postoperative pelvic lymph node metastases, and 37 (10.36%) patients had para-aortic lymph node metastasis. When pelvic lymph nodes had metastases, the para-aortic lymph node simultaneous metastasis rate was 30.00% (36/120). The risk of isolated para-aortic lymph node metastasis was 0.42% (1/237). There were no significant differences in the survival outcomes between the para-aortic lymph node unresected and resected groups. No differences in the survival outcomes were found before or after matching between the two groups regardless of pelvic lymph node negativity/positivity. Conclusion Para-aortic lymphadenectomy did not improve 5-year survival outcomes in surgical patients with stage IB1-IIA2 cervical cancer. Therefore, when pelvic lymph node metastasis is negative, the risk of isolated para-aortic lymph node metastasis is very low, and para-aortic lymphadenectomy is not recommended. When pelvic lymph node metastasis is positive, para-aortic lymphadenectomy should be carefully selected because of the high risk of this procedure.

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